Thesis (PhD)--University of South Australia, 1999

Thesis (M.S.)--University of Delaware, 2008. / Principal faculty advisor: Cheng-Shun (Richard) Fang, Dept. of Health, Nutrition, & Exercise Sciences. Includes bibliographical references.

Vitamin B12 and folate are necessary for bone marrow progenitor growth and division. Deficiencies are common in lymphoproliferative disorders due to increased demands of rapidly growing malignant cells. Isolated vitamin B12 deficiency is seen in 13% of these patients and may be their only manifestation. We present the case of vitamin B12 deficiency anemia due to an underlying malignancy that was discovered following supplementation. A 77-year-old nonsmoker female with chronic kidney disease and hypothyroidism presented to her internist with dyspnea, tachycardia and unintentional 7-pound weight loss. Age-appropriate cancer screenings were up-to-date. Physical exam was notable for an overweight female with tachycardia and trace ankle edema bilaterally. Electrocardiogram demonstrated sinus tachycardia. Labs were remarkable for hemoglobin 10.3 mg/dL (12.1 mg/dL one year ago) and serum B12/mL. She was started on intramuscular vitamin B12 supplementation. At her one-month follow-up, she reported debilitating gastrointestinal distress, rash, and fatigue lasting 5-6 days with every vitamin B12 injection. Physical exam was notable for 20-pound weight loss. Labs revealed hemoglobin 9.9 mg/dL despite serum B12 750 pg/mL and worsening kidney function with marked proteinuria. Additional work-up by primary team and subsequent Hematology & Oncology referral demonstrated elevated M-spike on urine protein electrophoresis and abnormal bone marrow biopsy suspicious for lymphoid malignancy. CT abdomen and whole body PET scan revealed increased uptake in the T12 vertebrae and multiple nodal basins consistent with stage IV lymphoma. Biopsy of vertebral body confirmed diffuse large B-cell lymphoma. The patient received one cycle of chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Her course was complicated by pathologic hip fracture requiring hospitalization and surgical repair. The patient died following cardiac arrest in the setting of septic shock from sigmoid colon perforation 7 months from initial presentation. Vitamin B12 and folate play critical roles in nucleic acid synthesis for bone marrow progenitors. Vitamin B12 deficiency arrests cell growth and division, leading to macrocytic anemia and various neuropsychiatric manifestations. It is a common diagnosis with numerous causes: autoantibodies to digestive proteins, poor dietary intake, small bowel malabsorption, etc. Diagnose with low hemoglobin (/dL or 13 mg/dL in non-pregnant women or men, respectively) and mean corpuscular volume >100 fL plus low serum B12 or elevated homocysteine and methyl-malonic acid levels. Replacement is given orally or intramuscularly. Vitamin B12 and folate deficiencies are found in lymphoproliferative disorders due to increased demands of rapidly growing malignant cells. Isolated vitamin B12 deficiency is seen in 13% of patients and may be the only clue. Replacement will not resolve their anemia. Physicians should monitor patients receiving supplementation. If anemia fails to improve or patients experience systemic symptoms, further investigation for lymphoid malignancies is warranted. This patient had dramatic deterioration with acceleration of underlying malignancy following vitamin B12 replacement. We believe supplementation enabled malignant lymphoid precursors to resume cell cycle growth and division. Only one report of vitamin B12 supplementation associated with unmasking a lymphoid malignancy exists in literature. Further research is needed to support whether supplementation can accelerate lymphoid malignancies.

Yes / Background: The incidence of self-reported premature hair graying (PHG) seems to be on the rise. PHG has a profound impact on the patient's quality of life. It remains an incompletely understood etiology with limited and modest treatment options. Aim: The evaluation of the demographic and clinical profile of patients with premature canities, and exploration of the association of this entity with certain systemic disorders suspected to be related to its etiology. Methods: Seventy-one cases of premature canities (onset noticed by patients before 25 years of age) presenting to an urban skin clinic in Gurugram, India, between September 2012 and September 2015 with this complaint were retrospectively analyzed. The patient records were retrieved that provided details of the onset, duration and pattern of involvement, history, and examination findings (scalp, cutis, and general physical). Since all these patients had been screened for anemia, thyroid disorder, fasting blood glucose, and Vitamin B12 levels at the time of presentation, these parameters were also available for analysis. Results: The mean age at onset of graying was 10.2 ± 3.6 years (range: 5–19 years), with an almost equal gender distribution. The earliest age of onset recorded was 5 years. A positive family history of PHG (at least one of the biological parents or siblings) was obtained in 64 (90.1%) of the cases. The temporal regions of the scalp (35.2%) were most commonly involved followed by the frontal region (18.3%). Hypovitaminosis B12 and hypothyroidism showed significant association with the disorder, whereas anemia, serum ferritin, and fasting blood glucose did not. Conclusion: The age of onset of hair graying can be as low as 5 years. Temporal and frontal areas are the most commonly involved sites. A strong family history, Vitamin B12 deficiency, and hypothyroidism are strongly associated with PHG. Larger case–control studies are mandated for discerning the correlation of these and other risk factors with PHG.

Thesis (MSc) -- Stellenbosch University, 1990. / ENGLISH ABSTRACT: The main aim of this workpiece was to establish the physiological parameters against which a vitamin Bu deficiency could be measured. A comparison between the hematological values of healthy patients and those suffering from pernicious anemia due to vitamin Bu deficiency was done. A specific case of pernicious anemia was used in the comparison of abnormal values to the values of normal healthy patients. The comparison consisted of blood analyses with the help of specified instruments, photomicrographs of bone marrow and blood smears and statistical data. A Coulter Counter Model ZF was used for the hematological analyses of blood, a radio-isotope assay for serum vitamin B u was done and photomicrographs were taken with a NIKON Microflex camera with photomicrographic attachments. The importance of vitamin Bu has been shown in this workpiece. With the use of techniques and certain instruments, the effects of a shortage of vitamin Bu has been shown. Analyses of the blood from normal ,healthy patients was compared to that of patients suffering from pernicious anemia. It was demonstrated that pernicious anemia is characterized by a low erythrocyte count, hematocrit (Het), hemoglobin (Hb) and vitamin Bu levels together with a higher mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV). In severe cases of pernicious anemia these levels are extremely high or low as the case may be. Together with these values, the investigation of pernicious anemic blood and bone marrow smears revealed abnormally large erythrocyte precursors and fewer leucocytes than normal. Abnormally shaped cells, called macrocytes, were seen which was due to the disruption in deoxyribonucleic acid (DNA) synthesis caused by the vitamin Bu deficiency. This study produced a set of hematological reference values. The comparative study between healthy and pernicious anemic patients demonstrated a significant drop in serum vitamin B12 values during pernicious anemia. The hematological effect was illustrated by the Coulter Counter blood analysis results and the microscopic examination revealed the presence of megaloblastic erythrocytes, oval erythrocytes, pear-shaped poikilocytes and polymorphonuclear neutropbils with hypersegmented nuclei in blood smears I during vitamin B12 deficiency. This dianoses can be supported by the presence of megaloblasts and metamyelocytes in pernicious anemic bone marrow. / AFRIKAANSE OPSOMMING: Die hoof doel van hierdie werkstuk was om fisiologiese grense te bepaal waarteen 'n vitamien B12 tekort gemeet kan word. 'n Vergelyking tussen die hematologiese waardes van gesonde persone en die van pasiente met pernisieuse anemie wat ontstaan het as gevolg van 'n vitamien B12 tekort was uitgevoer. Die waardes verkry vanaf 'n spesifieke geval van pernisieuse anemie. was vergelyk met waardes vanaf normale gesonde persone. Hierdie vergelyking het bestaan uit bloed analises, fotomikrograwe van bloed en beenmurg smere en statistiese data. Die hematologiese bloed analises was met behulp van 'n Coulter Teller model ZF uitgevoer. 'n Radio-isotoop bepaling vir serum vitamien B12 was gedoen en fotomikrograwe was met 'n NIKON Microflex kamera geneem. Die belang van 'n vitamien B12 tekort was in hierdie werkstuk gedemonstreer. Die effek van hierdie tekort is deur die gebruik van sekere instrumente en tegnieke aangedui en die resultate hiervan is vergelyk tussen gesonde persone en pasiente met 'n vitamien B12 tekort. Hierdie studie het bevestig dat pernisieuse anemie gekenmerk word deur verlaagde eritrosiet, hematokrit (Het), hemoglobien (Hb) en vitamien B12 vlakke tesame met verhoogde gemene korpuskulere hemoglobien (GKH) en gemene korpuskulere volume (GKV) vlakke. Gedurende ernstige gevalle van pernisieuse anemie kan hierdie waardes uitermatig hoog of laag wees. Benewens hierdie waardes het die ondersoek van bloed en beenmurg gedurende vitamien B12 tekort, abnormale groot eritrosiet voorgangers en 'n verminderde hoeveelheid leukosiete getoon. Abnormale sel vorms was ook sigbaar a.g.v. die onderbreking in DNA sintese wat deur 'n vitamien B12 tekort veroorsaak word. Pernisieuse anemie word verkry wanneer daar 'n vitamien B12 en/of folaat tekort in die dieet is of wanneer hierdie vitamiene nie geabsorbeer kan word nie. Die teenwoordigheid van makrosiete, ovaal eritrosiete, peervormige poikilosiete en polimorfonuklere neutrofiele met hipergesegmenteerde keme in bloedsmere dui op 'n megaloblastiese anemie. Hierdie diagnose kan ondersteun word deur die aanwesigheid van megaloblaste en reuse metamielosiete in die beenmurg. Die bepaling van vitamien B12 en folaat vlakke in die bloed kan as addisionele bewysstukke vir 'n volledige diagnose dien. Gedurende hierdie studie is daar 'n stel hematologiese verwysingswaardes vasgestel. Die vergelykende studie tussen gesonde persone en pasiente met pernisieuse anemie het getoon dat daar 'n beduidende verlaging in serum vitamien B12 waardes gedurende pernisieuse anemie is. Die hematologiese effek was ook duidelik waameembaar in die Coulter teller se bloed analiese en mikroskopiese ondersoeke het die · teenwoordigheid van makrosiete, ovaal eritrosiete, peervormige poikilosiete en polimorfenuklere neutrofiele met hipersegmenteerde keme in bloedsmere aangedui. Hierdie diagnose kan ondersteun word deur die aanwesigheid van megaloblaste en reuse metamielosiete in die beenmurg. / This study was financially aided by a bursary from the CSIR.

Includes bibliographical references (leaves 202-21). / 2 v. (xxiv, 409 leaves) : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Experiments were designed for the early detection of vitamin B12 deficiency in sheep and cattle. Metabolic indicators were examined in animals where deficiency was induced with either nitrous oxide (N2O) or by feeding diets of low cobalt content. Results showed that vitamin B12 dependent enzymes in the liver of ruminants appeared to be affected only at a late stage of deficiency. However changes in concentrations of metabolites of these pathways occured earlier. / Thesis (Ph.D.)--University of Adelaide, Dept. of Animal Sciences, 1994

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, İç Hastalıkları ve Doğum Anabilim Dalı, 2006. / Bibliyografya var.

A transcobalamina II (TCII) é a única proteína que leva a cobalamina (Cbl) para dentro das células. A TCII ligada a Cbl é denominada Holo-TC. Polimorfismos no gene TC2 podem alterar tanto a função como a concentração de Holo-TC. Os objetivos deste estudo foram avaliar se o parâmetro Holo-TC é um bom marcador de deficiência de Cbl; avaliar o efeito dos polimorfismos TC2 P259R, I23V e Q234R nos marcadores da deficiência da Cbl; verificar os fatores de predição para os valores de tHcy, SAM/SAH, MMA e Holo-TC nas gestantes e seus recém- nascidos. A Holo-TC não foi bom marcador para discriminar as gestantes com e sem deficiência de Cbl, diferente do encontrado no grupo de recém nascidos. Os genótipos matemos para os polimorfismos TC2 P259R e I23V não foram associados com as alterações nos valores matemos de tHcy, MMA e Holo-TC. Os neonatos portadores dos genótipos PR+RR apresentaram menores valores da razão SAM/SAH e maiores de MMA. Os neonatos com genótipos 23V+23VV apresentaram menores valores de SAM e maiores valores de tHcy. A combinação dos genótipos IV+VV/PR+RR no grupo de gestantes foi associada a menores valores de SAM. Já os neonatos com a mesma combinação de genótipos apresentaram menores valores de SAM e da razão SAM/SAH. O folato sérico foi o melhor fator de predição para a variação da tHcy materna, e a Cbl para os valores de Holo-TC, e finalmente a creatinina e a Cbl foram os fatores de predição para os valores de MMA. A Cbl e o folato foram os preditores para a tHcy neonatal quando foi utilizado apenas as variáveis independentes maternas no modelo de regressão linear múltipla. No entanto, quando as variáveis independentes foram as neonatais, Cbl, folato sérico e SAM/SAH neonatais foram as selecionadas para explicar os valores de tHcy neonatal. Para os modelos neonatais de MMA, a Cbl materna foi a única selecionada quando o modelo foi feito com variáveis independentes maternas. E noutro modelo da MMA neonatal, a Cbl e o genótipo PR + RR neonatal explicaram a variabilidade do MMA neonatal. Para a razão SAM/SAH neonatal, foram o folato sérico e o genótipo RR maternos as variáveis selecionadas quando só foram colocadas as variáveis independentes maternas no modelo. E finalmente, a tHcy e genótipos PR + RR foram as variáveis neonatais selecionadas no modelo de regressão linear múltipla para a razão SAM/SAH neonatal. Podemos concluir que os genótipos para os polimorfismos TC2 P259R e I23V não estão associados a variabilidade dos valores matemos dos metabólitos, no entanto, no recém nascido esta associação foi evidenciada. / Transcobalamin II (TCII) is the only protein that can take cobalamin (Cbl) into cells. When TCII is bound to the Cbl it is called Holo-TC. Polymorphisms inTC2 gene can alter both the function and the concentration of Holo-TC. The objective of this study was to evaluate whether the parameter Holo-TC is a good Cbl deficiency marker; to evaluate the effect of the polymorphisms TC2 P259R, I23V and Q234R in the Cbl deficiency markers; to verify the prediction factors for the values of tHcy, SAM/S~ MMA and Holo-TC in pregnant women and their neonates. Holo-TC has proved not be a good marker for discriminating pregnant women with Cbl deficiency from those without Cbl deficiency, unlike what was seen in the neonatal group. Maternal genotypes for polymorphisms TC2 P259R and I23 V were not related with the alterations ofmaternal values of tHcy, MMA and Holo-TC. The neonates presenting genotypes PR+RR showed lower SAM/SAH ratio values and higher MMA values. The neonates with genotypes 23V+23VV presented lower SAM values and higher tHcy values. The combination of genotypes IV+VV/PR+RR in the group of pregnant women was related with lower SAM values. On the other hand, the neonates presenting the same combination of genotypes presented lower SAM values and SAM/SAH ratio values. Se rum folate was the best predictor for the variation of the maternal tHcy, and Cbl for the Holo-TC values. The creatinine and the Cbl were the predictors for the values of MMA. Cbl and folate were the predictors for the neonatal tHcy when only the maternal independent variables were used in the multiple linear regression model. However, when the neonatal independent variables were used, Cbl, serum folate and SAM/SAH of neonates were selected to explain the neonatal tHcy values. For the neonatal models of MMA, only the maternal Cbl was selected for the model with maternal independent variables. In another neonatal MMA model, Cbl and neonatal PR + RR genotype explained the variability of the neonatal MMA. For the neonatal SAM/SAH ratio, serum folate and maternal RR genotype were the variables selected when only the maternal independent variables were used in the model. Finally, tHcy and genotypes PR + RR were the neonatal variables selected in the multiple linear regression model for the neonatal SAM/SAH ratio. We have concluded that the genotypes for the polymorphisms TC2 P25 9R and I23 V are not related to the variability of the maternal values of the metabolites; however, this relation is clear when evaluating the values observed in their newborn babies.

A transcobalamina II (TCII) é a única proteína que leva a cobalamina (Cbl) para dentro das células. A TCII ligada a Cbl é denominada Holo-TC. Polimorfismos no gene TC2 podem alterar tanto a função como a concentração de Holo-TC. Os objetivos deste estudo foram avaliar se o parâmetro Holo-TC é um bom marcador de deficiência de Cbl; avaliar o efeito dos polimorfismos TC2 P259R, I23V e Q234R nos marcadores da deficiência da Cbl; verificar os fatores de predição para os valores de tHcy, SAM/SAH, MMA e Holo-TC nas gestantes e seus recém- nascidos. A Holo-TC não foi bom marcador para discriminar as gestantes com e sem deficiência de Cbl, diferente do encontrado no grupo de recém nascidos. Os genótipos matemos para os polimorfismos TC2 P259R e I23V não foram associados com as alterações nos valores matemos de tHcy, MMA e Holo-TC. Os neonatos portadores dos genótipos PR+RR apresentaram menores valores da razão SAM/SAH e maiores de MMA. Os neonatos com genótipos 23V+23VV apresentaram menores valores de SAM e maiores valores de tHcy. A combinação dos genótipos IV+VV/PR+RR no grupo de gestantes foi associada a menores valores de SAM. Já os neonatos com a mesma combinação de genótipos apresentaram menores valores de SAM e da razão SAM/SAH. O folato sérico foi o melhor fator de predição para a variação da tHcy materna, e a Cbl para os valores de Holo-TC, e finalmente a creatinina e a Cbl foram os fatores de predição para os valores de MMA. A Cbl e o folato foram os preditores para a tHcy neonatal quando foi utilizado apenas as variáveis independentes maternas no modelo de regressão linear múltipla. No entanto, quando as variáveis independentes foram as neonatais, Cbl, folato sérico e SAM/SAH neonatais foram as selecionadas para explicar os valores de tHcy neonatal. Para os modelos neonatais de MMA, a Cbl materna foi a única selecionada quando o modelo foi feito com variáveis independentes maternas. E noutro modelo da MMA neonatal, a Cbl e o genótipo PR + RR neonatal explicaram a variabilidade do MMA neonatal. Para a razão SAM/SAH neonatal, foram o folato sérico e o genótipo RR maternos as variáveis selecionadas quando só foram colocadas as variáveis independentes maternas no modelo. E finalmente, a tHcy e genótipos PR + RR foram as variáveis neonatais selecionadas no modelo de regressão linear múltipla para a razão SAM/SAH neonatal. Podemos concluir que os genótipos para os polimorfismos TC2 P259R e I23V não estão associados a variabilidade dos valores matemos dos metabólitos, no entanto, no recém nascido esta associação foi evidenciada. / Transcobalamin II (TCII) is the only protein that can take cobalamin (Cbl) into cells. When TCII is bound to the Cbl it is called Holo-TC. Polymorphisms inTC2 gene can alter both the function and the concentration of Holo-TC. The objective of this study was to evaluate whether the parameter Holo-TC is a good Cbl deficiency marker; to evaluate the effect of the polymorphisms TC2 P259R, I23V and Q234R in the Cbl deficiency markers; to verify the prediction factors for the values of tHcy, SAM/S~ MMA and Holo-TC in pregnant women and their neonates. Holo-TC has proved not be a good marker for discriminating pregnant women with Cbl deficiency from those without Cbl deficiency, unlike what was seen in the neonatal group. Maternal genotypes for polymorphisms TC2 P259R and I23 V were not related with the alterations ofmaternal values of tHcy, MMA and Holo-TC. The neonates presenting genotypes PR+RR showed lower SAM/SAH ratio values and higher MMA values. The neonates with genotypes 23V+23VV presented lower SAM values and higher tHcy values. The combination of genotypes IV+VV/PR+RR in the group of pregnant women was related with lower SAM values. On the other hand, the neonates presenting the same combination of genotypes presented lower SAM values and SAM/SAH ratio values. Se rum folate was the best predictor for the variation of the maternal tHcy, and Cbl for the Holo-TC values. The creatinine and the Cbl were the predictors for the values of MMA. Cbl and folate were the predictors for the neonatal tHcy when only the maternal independent variables were used in the multiple linear regression model. However, when the neonatal independent variables were used, Cbl, serum folate and SAM/SAH of neonates were selected to explain the neonatal tHcy values. For the neonatal models of MMA, only the maternal Cbl was selected for the model with maternal independent variables. In another neonatal MMA model, Cbl and neonatal PR + RR genotype explained the variability of the neonatal MMA. For the neonatal SAM/SAH ratio, serum folate and maternal RR genotype were the variables selected when only the maternal independent variables were used in the model. Finally, tHcy and genotypes PR + RR were the neonatal variables selected in the multiple linear regression model for the neonatal SAM/SAH ratio. We have concluded that the genotypes for the polymorphisms TC2 P25 9R and I23 V are not related to the variability of the maternal values of the metabolites; however, this relation is clear when evaluating the values observed in their newborn babies.

This study aims to analyze the effect of an improvised user-generated health awareness campaign which was based on a personal narrative and first-hand experience with the B12 deficiency symptoms in babies and toddlers. The campaign was conducted in 2015 with a follow-up video in 2016 and shared through social media outlets, informing about the topic and empowering individuals to take responsibility for their own or their child’s health by providing information that could serve as a guideline for early diagnosis and intervention and by presenting an outlook of how people with similar issues manage the condition.The impact of the campaign is being qualitatively and quantitatively accessed by interviews with medical professionals and respectively survey data from a national survey and statistics from the YouTube console. In consideration has been taken the trust the respondents have in the medical service and the usual access to health information both online and offline The quantitative data were collected using a national online survey in which 1185 individuals took part. It aimed to additionally identify the general public attitude towards medical service in and the awareness about the vitamin B12. Four people participated in the interviews, divided into two groups - parents of children, who had symptoms similar to those, shown in the videos; and health practitioners who have seen the videos and comment on its qualities as a self-diagnosing material as well as the effect that attention to the issue created on their medical practices. The results confirmed that the personal narrative of a campaign could help to create identification and thus be more persuasive and with further increased sharing potential of the message through social media. The concrete campaign reached cumulatively over 167.000 people through YouTube, which is around 2.4% of the population of Bulgaria and possibly creating a lasting impact on the public attitude towards vitamin/mineral and other deficiencies. We found out that social media and YouTube could serve as an impactful medium for disseminating health-related information online when accurate and persuasive information is being used. When addressing a wide audience with little or no prior knowledge of the subject the personal narrative or testimonial could create more impact than a neutral fact-providing material.