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José Guillot A, Merino P, Bocchino A, O'Mahony C, Mª Giner R, Carmen Recio M, Garrigues TM, Melero A. Exploration of Microneedle-assisted Skin Delivery of Cyanocobalamin formulated in Ultraflexible Lipid Vesicles. Eur J Pharm Biopharm 2022:S0939-6411(22)00138-2. [PMID: 35787430 DOI: 10.1016/j.ejpb.2022.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/26/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022]
Abstract
Vitamin B12 (cyanocobalamin) deficiency is a widespread condition because of its different aetiologies, like malabsorption syndrome or lifestyles as strict veganism that is increasing its incidence and prevalence in developed countries. It has important haematological consequences that require pharmacological treatment. Current therapy consists of oral or parenteral supplements of cyanocobalamin; however, the oral route is discarded for malabsorption syndrome patients and the parenteral route is not well accepted generally. Topical treatments have been suggested as an alternative, but the molecular weight and hydrophilicity of cyanocobalamin limits its diffusion through the skin. Lipid vesicles can allow the transdermal absorption of molecules >500 Da. The aim of this work was to use different ultraflexible lipid vesicles (transfersomes and ethosomes) to enhance cyanocobalamin transdermal delivery. Vesicles were characterized and lyophilised for long-term stability. The ability to deliver cyanocobalamin through the skin was assessed in vitro using full-thickness porcine skin in Franz diffusion cells. As expected, the best transdermal fluxes were provided by ultraflexible vesicles, in comparison to a drug solution. Moreover, the pre-treatment of the skin with a solid microneedle array boosts the amount of drug that could potentially reach the systemic circulation.
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Jahangiri P, Hicks R, Batth PK, Haas CJ. Fooled by the fragments: vitamin B12 deficiency masquerading as thrombotic thrombocytopenic purpura. J Community Hosp Intern Med Perspect 2021; 11:397-403. [PMID: 34234915 PMCID: PMC8118444 DOI: 10.1080/20009666.2021.1893143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Thrombotic thrombocytopenic purpura (TTP) is a hematological emergency requiring prompt plasmapheresis. Conversely, vitamin B12 deficiency is a relatively benign diagnosis that can mimic microangiopathic hemolytic anemia, characterized by the presence of anemia, thrombocytopenia, indirect hyperbilirubinemia, markers of hemolysis, and schistocytes. This case series highlights the association of vitamin B12 deficiency and its TTP-like presentations. Cases: The first case describes a 72-year-old man with shortness of breath and weakness. Diagnostics were notable for pancytopenia, schistocytes, and a low reticulocyte index. Intriguingly, total bilirubin was only mildly elevated however LDH and Haptoglobin were elevated and low, respectively. Additional diagnostic workup demonstrated an undetectable B12, elevated methylmalonic acid and elevated homocysteine. Initiation of B12 supplementation resolved his pancytopenia. The second case describes a 57-year-old man with chest tightness, dyspnea on exertion, and night sweats. Diagnostic evaluation demonstrated pancytopenia, schistocytes, a low reticulocyte index, and a remarkably low B12. He had associated high methylmalonic acid and homocysteine levels, confirming the diagnosis. B12 supplementation resolved his pancytopenia. Conclusion: The polysymptomatic presentation of vitamin B12 deficiency-induced pseudothrombotic microangiopathy highlights the vitamin’s role in essential physiological cellular functions. Rapid recognition of the underlying etiology of microangiopathic hemolytic anemia is necessary as treatment approaches diverge greatly.
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Affiliation(s)
- Pegah Jahangiri
- MedStar Health Internal Medicine Residency Program, Medstar Health, Baltimore, MD, USA
| | - Rachel Hicks
- Department of Medicine, Saba University School of Medicine, Dutch Caribbean
| | - Prabjot K Batth
- Department of Medicine, Saba University School of Medicine, Dutch Caribbean
| | - Christopher J Haas
- MedStar Health Internal Medicine Program, MedStar Health, Baltimore, MD, USA.,Department of Medicine, Georgetown University School of Medicine, Washington, D.C., USA
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Al-Hamdi A, Al-Gahhafi M, Al-Roshdi S, Jaju S, Al-Mamari A, Al Mahrezi AM. Vitamin B12 Deficiency in Diabetic Patients on Metformin Therapy: A cross-sectional study from Oman. Sultan Qaboos Univ Med J 2020; 20:e90-e94. [PMID: 32190375 PMCID: PMC7065694 DOI: 10.18295/squmj.2020.20.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/12/2019] [Accepted: 11/14/2019] [Indexed: 02/07/2023] Open
Abstract
Objectives This study aimed to determine the prevalence of vitamin B12 deficiency amongst diabetic patients on metformin therapy. Methods This cross-sectional study was conducted at general clinics at the University Health Center and diabetes outpatient clinics at Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2017. All Omani adults who were diagnosed with type 2 diabetes mellitus and took metformin were invited to participate in the study. The variables included in this study were age, gender, duration of diabetes, dose and duration of metformin therapy, haemoglobin and glycosylated haemoglobin level. Results A total of 248 subjects were included (response rate = 95.4%) of which 26 (10.5%) were vitamin B12 deficient and 53 (21.4%) were borderline deficient. The mean daily dose of metformin was highest among vitamin B12 deficient group (1,981 ± 222 mg; P = 0.004). Conclusion The prevalence of vitamin B12 deficiency is considerable among diabetic patients on metformin therapy. Further research is needed to confirm the need for routine screening and monitoring.
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Affiliation(s)
- Ahmed Al-Hamdi
- Directorate of Health Services of North Batinah, Ministry of Health, Sohar, Oman
| | - Mohammed Al-Gahhafi
- Directorate General of Health Services of North Sharqiya, Ministry of Health, Mudhaibi, Oman
| | - Shihab Al-Roshdi
- Directorate of Health Services of North Batinah, Ministry of Health, Saham, Oman
| | - Sanjay Jaju
- Department of Family Medicine & Public Health, Sultan Qaboos University, Muscat, Oman
| | - Ali Al-Mamari
- Department of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Abdulaziz M Al Mahrezi
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital, Muscat, Oman
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Al-Batayneh KM, Salim Al Zoubi M, Al-Trad B, Hussein E, Al Khateeb W, Aljabali AAA, Bodoor K, Shehab M, Al Hamad MA, Eaton GJ, Cornelison CT. Homologous G776G Variant of Transcobalamin-II Gene is Linked to Vitamin B12 Deficiency. INT J VITAM NUTR RES 2019; 90:151-155. [PMID: 30761942 DOI: 10.1024/0300-9831/a000536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Vitamin B12 (Cobalamin) deficiency, due to improper internalization of cobalamin, is a metabolic disorder prevalent in impoverished and elderly populations and is associated with megaloblastic anemia and dementia. It has been suggested that mutations in transcobalamin II (TCN2) or gastric intrinsic factor (GIF) proteins can alter their binding efficiency to cobalamin or reduce the ability of their receptors to internalize them. In this case-control study, the correlation between vitamin B12 deficiency and alternative alleles of TCN2 and GIF was investigated in a Jordanian population. One hundred individuals with vitamin B12 deficiency (B12 < 200 mg/mL) were enrolled in our study to evaluate the TCN2 and GIF polymorphisms. The control group (B12 > 200 mg/mL) included 100 individuals. Our results indicated a significant association between the homologous variant of the TCN2 gene (G776G) and vitamin B12 deficiency, and an intermediate phenotype in heterozygous individuals (p < 0.001, OR = 5.6, 95% CI = 2.95 to 10.63). The GIF gene, however, showed no correlation between the A68G variant and vitamin B12 deficiency (p = 0.2). This study expounds the association of TCN2 polymorphism with cobalamin levels in a Jordanian population and highlights the necessity of further studies to elucidate the molecular basis and impact of TCN2 and GIF genes polymorphisms on vitamin B12 deficiency and associated disorders.
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Affiliation(s)
- Khalid M Al-Batayneh
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, Jordan
| | - Mazhar Salim Al Zoubi
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, Jordan.,Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Bahaa Al-Trad
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, Jordan
| | - Emad Hussein
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, Jordan.,Department of Food Science and Human Nutrition, College of Applied Sciences, A'Sharqiyah University, Ibra, Oman
| | - Wesam Al Khateeb
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, Jordan
| | | | - Khaldon Bodoor
- Department of Applied Biology, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Murad Shehab
- Department of Biological Sciences, Faculty of Science, Yarmouk University, Irbid, Jordan
| | - Mohammad A Al Hamad
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Kingdom of Saudi Arabia
| | - Greg J Eaton
- Department of Biological Sciences, Rowan University, New Jersey, USA
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Mashayekhi A, Ghayoumi A. Catatonia Development in a Patient with Bipolar Disorder Following Electroconvulsive Therapy: A Case Report. Iran J Psychiatry 2019; 14:109-112. [PMID: 31114623 PMCID: PMC6505046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective: Electroconvulsive therapy (ECT) is a major treatment of catatonia; and catatonia development during electroconvulsive therapy is a highly surprising phenomenon. We present a patient with bipolar disorder who developed catatonia during ECT. Case Reports : A 21-year-old woman, with a known case of bipolar disorder in manic phase without psychotic feature, history of long acting antipsychotic use, and severe B12 deficiency, was treated with ECT. Full catatonia syndrome developed after the fifth session of ECT. Conclusion: In rare cases, catatonia can develop during ECT course in the presence of some precipitating factors. Thus, these precipitating factors should be eliminated as much as possible before the start of ECT course to prevent catatonia development.
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Affiliation(s)
- Azadeh Mashayekhi
- Psychosomatic Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Address: Imam Khomeini Hospital, Psychosomatic Ward, Keshavarz Boulevard, Tehran, Iran. Postal Code: 1419733141. Tel: 98-2166922377, Fax: 98-2166922377,
| | - Alireza Ghayoumi
- Department of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
The first clinical application of nitrous oxide (N2O) was in 1844, by an American dentist named Horace Wells who used it to control pain during tooth extraction. Since then, N2O has shared a 170-year history with modern dental anesthesia. N2O, an odorless and colorless gas, is very appealing as a sedative owing to its anxiolytic, analgesic, and amnestic properties, rapid onset and recovery, and, in particular, needle-free application. Numerous studies have reported that N2O can be used safely and effectively as a procedural sedation and analgesia (PSA) agent. However, N2O can lead to the irreversible inactivation of vitamin B12, which is essential for humans; although rare, this can be fatal in some patients.
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Affiliation(s)
- Seong In Chi
- Department of Pediatric Dentistry, Dankook University Sejong Dental Hospital, Sejong, South Korea
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Petramfar P, Hosseinzadeh F, Mohammadi SS. Pseudo-Foster Kennedy Syndrome as a Rare Presentation of Vitamin B12 Deficiency. Iran Red Crescent Med J 2016; 18:e24610. [PMID: 27621919 PMCID: PMC5002969 DOI: 10.5812/ircmj.24610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 03/30/2015] [Accepted: 04/18/2015] [Indexed: 12/01/2022]
Abstract
Introduction Pseudo-Foster Kennedy syndrome is a triad consisting of ipsilateral optic atrophy, contralateral optic disc edema, and ipsilateral anosmia in the absence of an intracranial mass. Vitamin B12 plays an important role in DNA synthesis, and its deficiency causes peripheral neuropathy, myeloneuropathy, and, very rarely, optic neuropathy. Case Presentation In this study, we describe a 34-year-old male who presented with progressive loss of visual acuity and field. Fundoscopy showed optic disc edema with telangiectasia in the right eye, while the left eye had optic disc atrophy. We ruled out nearly all possible and common causes of optic neuropathy, and vitamin B12 deficiency was finally diagnosed. After treatment with vitamin B12, the patient improved. Conclusions Demyelinating disease, anterior ischemic optic neuropathy, non-arteritic anterior ischemic optic neuropathy, autoimmune disease, and hereditary optic neuropathy could cause optic neuropathy. Normal CBC parameters and the absence of clinical manifestations of vitamin B12 deficiency could not rule out its diagnosis. Careful physical examinations and history-taking with a classical approach led us to the diagnosis of vitamin B12 deficiency and its treatment.
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Affiliation(s)
- Peyman Petramfar
- Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Farideh Hosseinzadeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - S. Saeed Mohammadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: S. Saeed Mohammadi, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-9364402630, Fax: +98-7733444844, E-mail:
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El-Shafie K, Samir N, Lakhtakia R, Davidson R, Al-Waili A, Al-Mamary M, Al-Shafee M. Localised Skin Hyperpigmentation as a Presenting Symptom of Vitamin B12 Deficiency Complicating Chronic Atrophic Gastritis. Sultan Qaboos Univ Med J 2015; 15:e420-3. [PMID: 26357561 DOI: 10.18295/squmj.2015.15.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/10/2015] [Accepted: 03/30/2015] [Indexed: 11/16/2022] Open
Abstract
Vitamin B12 deficiency is common in developing countries and should be suspected in patients with unexplained anaemia or neurological symptoms. Dermatological manifestations associated with this deficiency include skin hyper- or hypopigmentation, angular stomatitis and hair changes. We report a case of a 28-year-old man who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in November 2013 with localised hyperpigmentation of the palmar and dorsal aspects of both hands of two months' duration. Other symptoms included numbness of the hands, anorexia, weight loss, dizziness, fatigability and a sore mouth and tongue. There was no evidence of hypocortisolaemia and a literature search revealed a possible B12 deficiency. The patient had low serum B12 levels and megaloblastic anaemia. An intrinsic factor antibody test was negative. A gastric biopsy revealed chronic gastritis. After B12 supplementation, the patient's symptoms resolved. Family physicians should familiarise themselves with atypical presentations of B12 deficiency. Many symptoms of this deficiency are reversible if detected and treated early.
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Affiliation(s)
- Kawther El-Shafie
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital
| | - Nafisa Samir
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital
| | - Ritu Lakhtakia
- Department of Pathology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Robin Davidson
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital
| | - Ahmed Al-Waili
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital
| | - Muna Al-Mamary
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital
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Khodabandehloo N, Vakili M, Hashemian Z, Zare Zardini H. Determining Functional Vitamin B12 Deficiency in the Elderly. Iran Red Crescent Med J 2015; 17:e13138. [PMID: 26430518 PMCID: PMC4585337 DOI: 10.5812/ircmj.17(6)2015.13138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 01/29/2014] [Accepted: 12/14/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated concentration of serum total homocysteine usually occurs in vitamin B-12 deficiency. This metabolite can be measured and used for screening functional vitamin B-12 deficiency. OBJECTIVES We assessed functional vitamin B12 deficiency in Tehranian elderly admitted to elderly research center, University of Social Welfare and Rehabilitation Sciences. PATIENTS AND MATERIALS A cross-sectional study was performed on 232 elderly admitted to elderly research center in Tehran, Iran in 2012. According to other studies, individuals were classified into two groups: high risk of vitamin B-12 deficiency (< 220 pmol/L) and borderline vitamin B-12 (220-258 pmol/L) accompanied by elevated homocysteine (> 15 micmol/L). RESULTS Cut-off of 15.0 pmol/L for homocysteine was identified for persons with normal or elevated concentrations. Among persons aged 65-74 and ≥ 75 years, respectively, 56% and 93% were at high risk of vitamin B-12 deficiency. CONCLUSIONS The prevalence of B12 deficiency was higher in this study compared to other studies, so more attention and massive efficacious policy should be designed to reduce the deficiency of this vitamin.
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Affiliation(s)
| | - Masoud Vakili
- Department of Hematology and Oncology, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Zahra Hashemian
- Department of Pediatrics, Hematology, Oncology and Genetics Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
- Corresponding Author: Zahra Hashemian, Department of Pediatrics, Hematology, Oncology and Genetics Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran, Tel: +98-3518224000, Fax: +98-3518224100, E-mail:
| | - Hadi Zare Zardini
- Department of Pediatrics, Hematology, Oncology and Genetics Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran
- Young Researchers and Elite Club, Yazd Branch, Islamic Azad University, Yazd, IR Iran
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Ko SH, Ko SH, Ahn YB, Song KH, Han KD, Park YM, Ko SH, Kim HS. Association of vitamin B12 deficiency and metformin use in patients with type 2 diabetes. J Korean Med Sci 2014; 29:965-72. [PMID: 25045229 PMCID: PMC4101785 DOI: 10.3346/jkms.2014.29.7.965] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 04/10/2014] [Indexed: 12/26/2022] Open
Abstract
We evaluated the prevalence of vitamin B12 deficiency and associated factors in type 2 diabetes patients using metformin. A total of 799 type 2 diabetes patients using metformin was enrolled. Vitamin B12 and folate levels were quantified by chemiluminescent enzyme immunoassay. Vitamin B12 deficiency was defined as vitamin B12 ≤ 300 pg/mL without folate deficiency (folate > 4 ng/mL). The prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes patients was 9.5% (n = 76), and the mean vitamin B12 level was 662.5 ± 246.7 pg/mL. Vitamin B12 deficient patients had longer duration of metformin use (P < 0.001) and higher daily metformin dose (P < 0.001) than non-deficient patients. Compared with daily metformin dose of ≤ 1,000 mg, the adjusted odds ratio for 1,000-2,000 mg, and ≥ 2,000 mg were 2.52 (95% CI, 1.27-4.99, P = 0.008) and 3.80 (95% CI, 1.82-7.92, P < 0.001). Compared with metformin use of < 4 yr, the adjusted odds ratios for 4-10 yr, and ≥ 10 yr were 4.65 (95% CI, 2.36-9.16, P < 0.001) and 9.21 (95% CI, 3.38-25.11, P < 0.001), respectively. In conclusion, our study indicates that patients with type 2 diabetes treated with metformin should be screened for vitamin B12 deficiency, especially at higher dosages (> 1,000 mg) and longer durations (≥ 4 yr) of treatment.
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Affiliation(s)
- Sun-Hye Ko
- Division of Endocrinology & Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun-Hee Ko
- Division of Endocrinology & Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu-Bae Ahn
- Division of Endocrinology & Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Ho Song
- Division of Endocrinology & Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Moon Park
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Seung-Hyun Ko
- Division of Endocrinology & Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye-Soo Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Safari A, Emadi F, Jamali E, Borhani-Haghighi A. Clinical and MRI manifestations of nitrous oxide induced vitamin B12 deficiency: A case report. Iran J Neurol 2013; 12:111-3. [PMID: 24250916 PMCID: PMC3829298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/20/2013] [Indexed: 11/11/2022]
Abstract
A 50 year-old man was referred with history of acute ataxia and lower extremity paresthesia 10 days after general anesthesia with nitrous oxide. Cervical MRI showed long hypersignal lesion in posterior segment of the cord. Blood analysis revealed vitamin B12 deficiency. Nitrous oxide-induced myelopathy should be considered in patients who develop acute neurological manifestation after general anesthesia. It is recommended for physicians to think about symptoms and signs of B12 deficiency when evaluating patients in postoperative visits.
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Affiliation(s)
- Anahid Safari
- Department of Pharmacology, School of Medicine, Azad University, Kazerun Branch, Shiraz, Iran
| | - Farhad Emadi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Jamali
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Borhani-Haghighi
- Research Center for Traditional Medicine and History of Medicine AND Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
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